Interoperability at top of CMS, White House agenda

Interoperability is a top priority for the Centers for Medicare and Medicaid Services and the White House as well, according to Kate Goodrich, MD, chief medical officer and director of the CMS Center for Clinical Standards and Quality.

There’s “lots of ongoing work around interoperability,” including coordination with the Office of the National Coordinator for Health IT and the Department of Veterans Affairs, said Goodrich during Wednesday’s HIT Advisory Committee Meeting.

“We are looking very broadly at all of the levers we have within CMS around how we can promote interoperability,” she added. “There were a number of roundtables held at the White House around this topic, which actually gave us a lot of terrific ideas that we are actively exploring. You will see some provisions intended to enhance the ability for folks to have access to their data from a patient-centric point of view.”

Goodrich emphasized that the Trump administration’s framework for interoperability is based on ensuring patients have access to their health information in a secure, timely and valuable manner. “You will start to see more from us—as well as from ONC—over the coming months around this,” Goodrich concluded at the HITAC meeting.

At last month’s HIMSS18 conference in Las Vegas, CMS announced the launch of the MyHealthEData initiative, led by the White House Office of American Innovation, to put patients in control of their own health data.The MyHealthEData initiative will “declare to hospitals and insurers that the practice of holding patients hostage in their systems and blocking their data will no longer be tolerated,” said CMS Administrator Seema Verma. “It’s not acceptable to limit patient records or to prevent them and their doctor from seeing their complete history outside a particular healthcare system.”

Under the MyHealthEData initiative, Verma said CMS will be announcing an overhaul of the Meaningful Use program to save time and costs, including:

Streamlining the Medicare and Medicaid EHR Incentive Programs for eligible hospitals and critical access hospitals, and the Quality Payment Program for clinicians (part of MACRA) to increase the programs’ focus on interoperability and to reduce the time and cost required to comply with them.

Prioritizing the use of quality measures and improvement activities in value-based care and quality programs that lead to interoperability.

Taking steps against information blocking, requiring hospitals and clinicians under some CMS programs to show they have not engaged in data blocking activities.

John Fleming, MD, deputy assistant secretary for health technology reform, told Wednesday’s HITAC meeting that regardless of “whether you feel like government has a larger role in healthcare or a lesser role, we all agree that we need to lower the cost of delivery of healthcare—and, that’s where we come in.”

Fleming said that the approach will involve enhancing “data liquidity” and giving patients access to their health information “so the patient can shop for cheaper, more valuable care.” He added that with clinicians spending more time entering data into electronic health records and less time engaged in direct patient care, the role of policy is intended to help reduce the documentation burden on providers.

“A caveat to keep in mind, though, is the increasing cognitive and time burden placed on the people who actually put the information in the system,” according to Fleming. “Fifty percent or more of a provider’s time is spent in non-direct care for the patient. That’s a huge loss of productivity, which again gets back to the cost of care.”

He made the case that, as the HITAC makes policy recommendations, the committee should consider “how they apply to the independent practitioner out there—if you can fix it for him or her, then everybody else will be fine as well.”

The 21st Century Cures Act directed ONC, in partnership with CMS, to establish a goal and develop a strategy for reducing regulatory and administrative burdens related to the use of EHRs. Specifically, the agencies have set their sights on reducing the burden of Evaluation and Management (E&M) codes on physicians. E&M coding is part of the process by which physician-patient encounters are translated into five-digit Current Procedural Terminology (CPT) codes, which are submitted to insurers for payment.

“What everybody says is that the one probably biggest burden is the E&M codes,” said Fleming last month at the HIMSS18 conference in Las Vegas. “The E&M codes are really the flashpoint in all of this.”